America’s Health Deficit: Dying From Policy Neglect

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From the Editor-In-Chief Health AffairsVol. 32, No. 3: Promoting Health & Wellness America’s Health Deficit: Dying From Policy NeglectSusan DentzerPUBLISHED:March 2013Free Accesshttps://doi.org/10.1377/hlthaff.2013.0175AboutSectionsView PDFPermissions ShareShare onFacebookTwitterLinked InRedditEmail ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsDownload Exhibits TOPICSCost savingsLife expectancyPrescription drugsWellness plansHealth gapsMortality ratesCosts and spendingMortalityAccess to careDrug use Even as the nation’s policy makers feud over fiscal deficits, they seem largely clueless about another shortfall: the nation’s large, and growing, health gap. A sobering report from the Institute of Medicine, U.S. Health in International Perspective , notes that US life expectancy is decidedly lower than that of at least 16 other countries that we might consider our global peers. What’s more, the report adds, the United States has “a longstanding pattern of poorer health” that is also “strikingly consistent and pervasive over the life course,” from birth to old age. A cluster of articles in this month’s Health Affairs plumbs the parameters of this health gap, and also explores one of the popular counter-measures against it: workplace wellness programs. Laudable as these programs are, it’s tough to escape the conclusion that they are up against so many more powerful social and economic forces that they’re roughly akin to the image of the little Dutch boy holding back the sea with his finger in a dike. Social Breakdown?This month’s tour of America’s poor health terrain begins with the article by David Kindig and Erika Cheng. Examining longitudinal trends in 3,140 US counties, they found—shockingly—that female mortality rates have increased in 42.8 percent, while male mortality rates increased in 3.4 percent.Echoing findings of earlier studies that have shown falling life expectancy for women in these areas, these authors see a link to smoking and lack of education, plus a pervasive problem in the South and the West. These findings underscore the need for “increased public and private investment in the social and environmental determinants of health,” rather than increased health care expenditures.Jessica Ho tells a related tale, pointing out that mortality differences below age 50, rather than at older ages, explain much of the gap in life expectancy between Americans and our rich-country counterparts. The single biggest contributor is unintentional injuries, which account for roughly a third of excess US mortality in that age bracket.Homicide and suicide are a component of these injuries, fed by Americans’ broad access to guns. (Apropos of that fact, readers should also take in this issue’s Entry Point, in which David Shern and Wayne Lindstrom discuss the post-Newtown response to mental illness and gun violence.) Ho highlights the role of “accidental poisonings”—literally, deaths from drug overdoses, through abuse of prescription drugs containing hydrocodone and oxycodone, as well as illegal drugs like heroin and cocaine.Ho links some of these mortality-inducing trends to the fact that the United States, like Canada and Australia, is a “liberal” welfare state, and as such provides less comprehensive social services compared to our peers. So problems we don’t head off or address in the social welfare system end up in our costly health care system instead—like the gunshot victim in the emergency department, or the obese woman in the hospital with smoking-related emphysema and drug addiction.Workplace Wellness Having left so many predisposed to ill health, we’re now calling on private-sector employers to pick up the pieces—handing them new incentives under the Affordable Care Act to broaden wellness programs. A number of previous Health Affairs articles have debated the merits of these programs and, in particular, whether they result in any cost savings for employers. With this issue, we add two more. Gautam Gowrisankaran and coauthors studied a program put in place by BJC HealthCare, a hospital system in St. Louis, Missouri, and found that it did lead to sharply less hospitalization of workers—but also some offsetting care costs and no overall decrease in health spending. The authors conclude that wellness programs may have value in improving health for some workers and boosting workplace productivity, but savings from lower health costs in the short run aren’t likely.Jill Horwitz and coauthors, meanwhile, examine randomized controlled trials of wellness programs and identify critical issues—particularly in those designed to benefit employees who exhibit healthy behavior. They posit that savings to employers who’ve instituted these programs effectively come from shifting costs to employees with greater health risk. Reinforcing the dynamics described above, these tend to be people from lower socioeconomic strata who are predisposed to ill health. “Little is likely to happen until the American public is informed” about America’s health deficit, the IOM study concluded. Consider this month’s Health Affairs one small step in spreading the word. Loading Comments... Please enable JavaScript to view the comments powered by Disqus. DetailsExhibitsReferencesRelated Article MetricsCitations: Crossref 2 History Published online 1 March 2013 Information Project HOPE—The People-to-People Health Foundation, Inc. PDF downloadCited byAccountable Care and Evidence-Based Decision MakingAccountable Care and Evidence-Based Decision Making